Home-based treatment with local therapeutic food helps tackle child malnutrition in India: Trial
That was the key finding of a study which assessed 906 children aged between six and 59 months.
The children enrolled were randomised to receive centrally produced ready-to-use therapeutic food (RUTF-C) or locally prepared ready-to-use therapeutic food (RUTF-L) for home-based feeding.
For these groups, a micronutrient preparation providing the recommended daily intake of vitamins and minerals for a child with was given to caregivers, to be added to a cooked meal prior to feeding.
Its impact was then compared with a group given micronutrient-enriched, energy-dense, home-prepared foods (A-HPF).
Writing in the journal BMJ Global Health, researchers said: “We provided foods, counselling and feeding support until recovery or 16 weeks, whichever was earlier and measured outcomes weekly (treatment phase). We subsequently facilitated access to government nutrition services and measured outcomes once 16 weeks later (sustenance phase). The primary outcome was recovery during treatment phase.”
Recovery rates with RUTF-L, RUTF-C and A-HPF were 56.9%, 47.5% and 42.8%, respectively.
Weight gain in the RUTF-L group was also higher than in the A-HPF group, with time to recovery shorter in both RUTF groups.
Researchers said this showed that children with uncomplicated severe acute malnutrition can be managed at home with RUTF, instead of through inpatient hospitalisation.
Of the 20m children with severe acute malnutrition worldwide, over 8m are from India.
“This is the first randomised trial evaluating RUTFs with energy-rich and nutrient-rich home foods for the management of children with severe acute malnutrition without complications,” said the researchers.
Free of cost
“Our main finding is that in an efficacy study, locally produced RUTF is superior to A-HPF in achieving recovery. Our study confirms the findings of quasi-randomised trials in Malawi on the efficacy of RUTF compared with standard diets for home management of children.
“In this trial, about half the children recovered with a package of interventions that included diets of high nutritional value provided free of cost, peer support for feeding, antibiotics at the initiation of treatment and increased access to healthcare for morbidity.”
However, they cautioned that the gains observed during the initial 16 weeks of treatment then started to decline.
They argued new approaches needed to be considered to improve long-term outcomes including prolonged use of a RUTF-L.
“Setting up local units for production of RUTF does not require huge investment in terms of equipment, infrastructure or personnel. The procedures for production are systematic and simple to replicate,” they concluded.
Source: BMJ Global Health
DOI: 10.1136/bmjgh-2016-000144
“Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition: a randomised trial in India”.
Authors: Nita Bhandari, et al.
